Medicaid 1I write to you as an Ohioan and conservative. Because of Governor John Kasich’s relentless push to expand Medicaid under the Patient Protection and Affordable Care Act, you face a momentous decision in the next sixty days: do you give in to Governor Kasich and Democrats by expanding Medicaid, or do you resist the pressure and keep greater control over Ohio’s future finances? Make no mistake, given the forty-four year history noted in Figure 7 below, expanding Medicaid is akin to writing a blank check because no one has any real idea about (1) how many new enrollees will show up and (2) how much each of those new enrollees will cost. Estimates of expansion range from Governor Kasich’s low-ball estimate of 275,000 new enrollees to the Kaiser Commission’s estimate of nearly 900,000 new enrollees.

Keep in mind, back when President Lyndon Johnson launched the Great Society and Medicaid in 1966, the federal government claimed it would cost $35.3 million in Ohio in 1967. In fact, it cost $67.4 million – nearly twice as much as promised. What began as a $1 billion national entitlement is projected to hit $900 billion by 2020. In 2012, Ohio Medicaid spending hit $17 billion—a 25,123% increase in 45 years!

Medicaid 2In terms of future costs, Matt Salo, the Executive Director of the National Association of Medicaid Directors noted in testimony: “More people show up than you think will show up, and the people that show up are sicker than you expected.” If—and that “if” is a big one—the debt-ridden federal government keeps its commitment to fund expansion at 90 percent, the 10 percent Ohioans will have to pay is 10 percent of an unknown number. That unknown number is a blank check you will not be able to control or predict no matter what expansionists say. Please don’t fall prey to the temptation that you can cut deals for expansion—whatever “reforms” you try to get will barely impact the unknown costs associated with adding hundreds of thousands of able-bodied Ohioans to the entitlement rolls. And, no politician will kick people off the rolls should Washington break its funding promise.

Every future state tax dollar spent on Medicaid expansion is a dollar that must be taken from Ohioans and that cannot be spent on other priorities like educating our kids. As Figure 9 above shows, Americans now spend more on Medicaid than on making sure our children can compete in the 21st century. Expanding Medicaid will expand that spending differential even more and swallow other spending priorities, as well.

I know I can’t compete with the campaign funding from the Hospital Industrial Complex, the emotional appeal of liberal-progressives, the bully pulpit of Governor Kasich, and the collective lobbying by and adoration of the major newspapers to expand Medicaid. I can only appeal to your fiscal prudence and principles. I am confident you did not run for elected office so you could expand one of the largest federal entitlement programs in existence that already costs too much and gets mediocre to poor results for current recipients. I know you did not throw your hat into the arena of politics to expand one of the core components of the Great Society. I firmly believe you did not ask for the campaign contributions, votes, and volunteer efforts of Main Street Ohioans so you could begin or end your political career leaving a legacy of an expanded Medicaid program that will require ever higher levels of government spending and taxes.

Voting to expand Medicaid – when you have a chance for once to say “Enough!” to Washington – would be wholly inconsistent with the core philosophies of limited government, fiscal restraint, and good government. That is why 65 percent of Republican voters and 62 percent of independent voters in Ohio oppose Medicaid expansion (at p. 182). More specifically, Republican and independent voters oppose Medicaid for two overarching, common sense reasons: (1) Medicaid already is so riddled with waste, fraud, abuse, and bureaucracy, that expanding it would be reckless (at p. 214) and (2) the huge level of uncertainty on the future costs of expanding Medicaid renders expansion fiscally irresponsible (at p. 246).

That is also why more than twenty other states have rejected Medicaid expansion, thereby preventing half a trillion dollars in deficit spending that our kids and grandkids would have had to pay. The only Ohio voters who support expanding Medicaid are Democratic voters who will not vote for you no matter what you do (at p. 182). With your enormous fundraising advantage, the Hospital Industrial Complex won’t dare fund the Democratic House and Senate Caucuses given the realities of redistricting.

And you should ignore the threat of the Hospital Industrial Complex to put a ballot initiative to voters in 2014—a midterm election experts believe will be a referendum on ObamaCare. Between the lack of support for expansion by Republicans and independents and the month-by-month deterioration of support for ObamaCare plus the 2011 supermajority vote by Ohioans for the Healthcare Freedom Act, no amount of spending will convince a majority of Ohioans to expand a federal entitlement program that costs too much, gets weak results, and requires a blank check by Ohioans. Let them waste money trying.

So whether you are a first term legislator just starting out or a conservative caveman in your 35th year, stick with your base and the persuadable middle, your conservative principles, and your common sense knowledge that expanding Medicaid will cost more than they say and not truly help those they claim to be helping. We’ll never get the power and money out of Washington if we keep expanding its power over our lives and pocketbooks.

You have a fundamental choice to make. Make the right one.

Matt A. Mayer
Dublin, Ohio

(This is a personal letter from Matt Mayer, President of Opportunity Ohio)